Today we are going to talk about Chapter 14
in the ICD-10-CM code book. Chapter 14 is the
Diseases of the Genitourinary System-
the 2017 guidelines. The first guideline
has to do with stages of chronic kidney
disease. You will often see this
abbreviated as "CKD". Our scenario says
Stage 5 chronic kidney disease with
ESRD, which is end stage renal disease
requiring chronic dialysis. Even though
our scenario says "stage five", the fact
that it also states end stage renal
disease, we're going to code only the
end-stage renal disease which is N18.6.
Our guidelines tell us to do that. I
have it here in a purple font on the
right. You can see the guideline I'm
going by. Our index pathway's given there,
where I've shown you yes, there are two
different codes for Stage 5 and end
stage renal disease but we do not code
the stage 5; we only code the end stage
renal disease. We want to pick up on the
status dialysis which the guidelines
tell us when to pick up on these status
codes. Sometimes they don't, so I would
make a note there if you are in your
codebook and you're looking at stage
5 or end stage renal disease. if you
have documentation that states the
patient is on dialysis. you will need to
add to Z99.2 code. The next guideline
has to do with chronic kidney disease
and kidney transplant. You can get
chronic kidney disease with a
transplanted kidney. The example we're
given here is a patient has residual
CKD stage 1 after a kidney transplant.
Our guidelines tell us that we would
assign the appropriate N18 code,
which in this case, stage 1 is N18.1
as well as the Z94.0 kidney transplant
status. Both of those things would be
included.
When you have chronic kidney disease
with other conditions, for example,
diabetes, it is not uncommon to see those
together. The scenario given is a type 1
diabetic chronic kidney disease stage 2
and we would code the diabetes first and
then the chronic kidney disease second
The sequencing of the (CKD) code
in relationship to codes for other (contributing)
conditions is based on the conventions
in the Tabular. The Tabular tells us
that the diabetes code would be first,
with an instructional note that says "use
additional code to identify the stage
of chronic kidney disease (N18.1-N18.5). Many times
the guidelines will tell us how to
sequence codes. Any questions about the
Chapter 14 coding guidelines. please post
in the discussion board. It's
pretty straightforward, but there may be some
questions that come up. Also be sure that
you look at the instructional notes at
the beginning of each category. I did not go over them
at the beginning of this chapter. There are
several Excludes 2 conditions listed
and you recall Excludes 2 means you
could have any of these kidney or renal
conditions as well as those things in
that Excludes 2 list. Be sure and
look at that from time to time to be
sure, be certain that you are
remembering what the Excludes 1 and
Excludes 2 notes are for any given
chapter. Thank you so much and have a
good day.